March 7, 2018

As the first cohort of students to use the OHSU School of Medicine's YOUR M.D. curriculum approaches Match Day and graduation, Academic Medicine, the journal of the Association of American Medical Colleges, has published an article reviewing OHSU's process, including factors that helped and hindered change.

"Describing the Journey and Lessons Learned Implementing a Competency-Based, Time-Variable Undergraduate Medical Education Curriculum," by George Mejicano, M.D., M.S., senior associate dean for education, and Tracy Bumsted, M.D., M.P.H., associate dean for undergraduate medical education, describes the forces driving change and how OHSU tailored the new curriculum to respond.

Drs. Mejicano and Bumsted cite among the driving factors the "explosion of medical knowledge," new disciplines and educational methods, and "the profound economic pressures borne by health care delivery systems and payers." Another key factor is that incoming medical students are now overwhelmingly digital natives.

"The goal of the new curriculum was to effectively prepare graduates for residency training and professional practice to best serve and meet the needs of society in the 21st century," they wrote.

A more active, competency-based approach

For these reasons, the YOUR M.D. curriculum, launched in August 2014, moves away from a one-size-fits-all, lock-step curriculum to a more personalized, interactive curriculum that emphasizes the demonstration of competency in core areas.

The YOUR M.D. curriculum allows students to begin the clinical phase of the curriculum in February of their second year, earlier than before. The curriculum also favors active learning – through simulation, transition courses, creative clinical experiences, reflective writing and scholarly projects. The latter requires students to do a "deep dive" about a topic or issue of their choosing. The work of the graduating class will be showcased on March 9 when the students present their project capstone posters.

"A real moment of pride for me has been to see our students in clinical settings so much earlier than before," said Dr. Bumsted. "After mastering the essence of the skills required, they go on to learn by doing, allowing experience to be the best teacher."

In addition, every student is assigned a coach for the entire program. Together, they design an individualized learning plan that can take into account previously attained knowledge and skills. The idea is that students will be able to graduate whenever they can demonstrate that they can perform at a predetermined level across each of the 43 competencies selected by the school's faculty.

Although some students may take longer than four years to graduate, many more should finish earlier than scheduled. Indeed, 31 students from the M.D. class of 2018 will graduate at the end of winter term (i.e., three months ahead of schedule). This has the added advantage of decreasing student debt.

Challenges and learnings

Drs. Mejicano and Bumsted reflect in the article on challenges during the transformation, including resistance to change and regulatory barriers.

They note, however, that students who were going to benefit from the new curriculum were largely supportive. A hallmark of the transformation has been to empower students to give feedback on how to improve the curriculum. As a result, the article notes, "multiple new feedback systems are now in place, such as town halls, surveys and meetings with student leaders, to give input."

Indeed, Drs. Mejicano and Bumsted credit the dialogue with the M.D. class of 2018 and the opportunity to learn from their experience with the new curriculum as key to what will eventually become its full implementation. "Their overall progress, both in terms of time to and ease of achieving the intended outcomes, has helped us better understand this process and make ongoing innovative curricular changes in real time," the authors wrote.

As they prepare to celebrate Match Day and graduation with the class, both expressed a sense of determination to complete the work as well as gratitude.

"When you're making significant change in order to meet a demonstrated need, it is not always easy, but it is necessary, to persevere," Dr. Mejicano said. "We know that many aspects of this change have been challenging. And we appreciate and are grateful to our faculty and students because they have been integral to the successful transformation of the curriculum. Most importantly, however, is that we believe that our students will be better prepared to enter residency and practice medicine."

Photo: Dr. Bumsted congratulates Sophia Hayes, M.D. class of 2018, on being recognized for her scholarly project. Hayes' class will be the first cohort to complete YOUR M.D.